Provider Demographics
NPI:1548267164
Name:PEPKOWITZ, SAMUEL HERSCHEL (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:HERSCHEL
Last Name:PEPKOWITZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:31255 CEDAR VALLEY DR
Mailing Address - Street 2:STE 324
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4014
Mailing Address - Country:US
Mailing Address - Phone:818-338-8103
Mailing Address - Fax:818-338-8119
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:ROOM 8725
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:818-338-8103
Practice Address - Fax:818-338-8119
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2018-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG044156174400000X
CAG44156207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49568Medicare UPIN